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The Ashley Smith inquest has raised questions about what should be done for women like her — self-harming inmates in Canada’s federal prison system, who have serious mental health issues.

The Toronto inquest was told there are anywhere from about 20 to 40 women in prison on any given day who cut or bite themselves, head bang, ingest objects or self-asphyxiate.

Though they are a small subset, their impact on the prison system is significant, the inquest heard.

Daily counts of Canada’s federal prison system say there are 15,000 incarcerated men and women — just over 600 of them female, according to the Office of the Correctional Investigator, the ombudsman for federal prisoners.

Last year, of those 15,000, there were 264 inmates who self-harmed in about 900 reported incidents. Only 37 of the inmates were women but they accounted for more than a third of the incidents, Correctional Investigator Howard Sapers said in his recent report, Risky Business, a study into how chronic self-harming females in the federal system are treated and managed.

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Kim Pate, executive director of the Canadian Association of Elizabeth Fry Societies, noted that preparations are underway for an inquest into the death of another woman who died in federal custody.

Kinew James, 35, was an inmate at the Regional Psychiatric Centre in Saskatoon who died in January.

Chronic self-injury among female offenders continues to be routinely met with “control and security-focused responses,” Sapers said. Pepper spray, segregation, physical restraints, disciplinary (and sometimes criminal) charges and institutional transfers. But these measures only escalate tensions and don’t get at the root of the women’s problems, he said.

These “handful of mentally disordered women offenders” have symptoms, behaviours and severity of illness that are beyond the ability of Correctional Service of Canada to handle, he said.

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Among the sweeping list of recommendations were calls for:

Corrections to restrict the use of segregation and seclusion to 15 consecutive days;

Inmates placed in restraints to be given one-on-one therapeutic support for their entire time in restraints.

One key recommendation in Sapers’ study calls for “necessary and immediate measures” to transfer the most chronic and complex self-harming women offenders who are mentally ill, to “external” community psychiatric centres, such as provincial hospitals.

This is similar to the Smith inquest jurors’ call for self-harming women to be sent to “federally operated’’ treatment facilities that aren’t security-focused.

Corrections Canada Commissioner Don Head told Ashley’s inquest his service has limited clinical resources to treat their most difficult cases and he talked about outsourcing their care to provincial systems.

In fact, Corrections already has agreements with Institut Philippe Pinel in Montreal, a secure psychiatric treatment centre. Ashley stayed there for about a month in the spring of 2007.

Corrections has also sent women to the St. Lawrence Valley Treatment Centre in Brockville and other provincial mental health hospitals with secure treatment units.

Dr. John Carlisle, presiding coroner at the inquest into the segregation-cell death of teenager Ashley Smith, is seen in a Toronto courtroom in November. (Colin Perkel / THE CANADIAN PRESS)

Dr. John Carlisle, presiding coroner at the inquest into the segregation-cell death of teenager Ashley Smith, is seen in a Toronto courtroom in November. (Colin Perkel / THE CANADIAN PRESS)

Dr. John Carlisle, presiding coroner at the inquest into the segregation-cell death of teenager Ashley Smith, is seen in a Toronto courtroom in November. (Colin Perkel / THE CANADIAN PRESS)

“We have recommended that (Corrections) expands these kind of agreements,” says Ivan Zinger, executive director and general counsel for the Correctional Investigator.

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